High-dose-rate interstitial brachytherapy in recurrent and previously irradiated head and neck cancers-Preliminary results Journal Article

Authors: Narayana, A.; Cohen, G. N.; Zaider, M.; Chan, K.; Lee, N.; Wong, R. J.; Boyle, J.; Shaha, A.; Kraus, D.; Shah, J.; Zelefsky, M. J.
Article Title: High-dose-rate interstitial brachytherapy in recurrent and previously irradiated head and neck cancers-Preliminary results
Abstract: Purpose: Although high-dose-rate brachytherapy (HDRBT) offers significant advantages over low dose rate brachytherapy, there are scant data on improved local control (LC) and treatment-related complications in patients with recurrent head and neck (H&N) cancers. We report our preliminary results in patients with recurrent H&N cancers treated with interstitial HDRBT. Methods and materials: Thirty patients with recurrent H&N cancers were treated with HDRBT between September 2003 and October 2005. Seventy-seven percent (23/30) of the patients had either local or regional recurrence in the area of previous external beam radiation therapy. The treatment sites were oral cavity/oropharynx (11/30), neck (10/30), face/nasal cavity (6/30), and parotid bed (3/30). Whereas 18 patients underwent surgical resection followed by HDRBT, 3 patients were treated with combined external beam radiation and HDRBT, and the remaining 9 were treated with HDRBT alone. The dose and fractionation schedules used were 3.4 Gy twice per day (b.i.d.) to 34 Gy for postoperative cases, 4 Gy b.i.d. to 20 Gy when combined with 40-50 Gy external beam, and 4 Gy b.i.d. to 40 Gy for definitive treatment. HDRBT was initiated 5 days after catheter placement to allow for tissue healing. Results: With a median followup of 12 months, 6 local recurrences were observed 1-10 months after the procedure. The 2-year LC and overall survival outcomes for the entire group were 71% and 63%, respectively. Patients treated with surgical resection and HDRBT had an improved 2-year LC compared to the patients treated with HDRBT ± external beam radiation alone (88% vs. 40%, p = 0.05). Six Grade II and four Grade III complications were noted in five patients, all observed in the postoperative HDRBT group. Conclusion: The preliminary results of HDRBT indicate an acceptable LC and morbidity in recurrent H&N cancers. A planned surgical resection followed by HDRBT is associated with improved tumor control in these high-risk patients. Based on these encouraging results, prospective clinical trials are warranted using HDRBT in recurrent H&N cancers to decrease late toxicity. © 2007 American Brachytherapy Society.
Keywords: adult; cancer survival; clinical article; controlled study; treatment outcome; aged; aged, 80 and over; middle aged; survival analysis; cancer surgery; retrospective studies; carcinoma, squamous cell; recurrent cancer; follow up; follow-up studies; adenocarcinoma; melanoma; pain; neoplasm recurrence, local; radiotherapy dosage; time factors; sarcoma; fibrosis; dysphagia; head and neck cancer; head and neck neoplasms; tumor burden; radiation dose fractionation; radiation injuries; brachytherapy; external beam radiotherapy; speech disorder; carcinoma, basal cell; cranial nerve paralysis; trismus; bone necrosis; hearing loss; hdr brachytherapy; recurrent tumor; hemibody irradiation
Journal Title: Brachytherapy
Volume: 6
Issue: 2
ISSN: 1538-4721
Publisher: Elsevier Science, Inc.  
Date Published: 2007-04-01
Start Page: 157
End Page: 163
Language: English
DOI: 10.1016/j.brachy.2006.12.001
PUBMED: 17434110
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 11" - "Export Date: 17 November 2011" - "CODEN: BRACC" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Michael J Zelefsky
    655 Zelefsky
  2. Dennis Kraus
    265 Kraus
  3. Ashok R Shaha
    552 Shaha
  4. Jay O Boyle
    98 Boyle
  5. Gilad N Cohen
    139 Cohen
  6. Nancy Y. Lee
    582 Lee
  7. Richard J Wong
    238 Wong
  8. Marco Zaider
    169 Zaider
  9. Jatin P Shah
    565 Shah
  10. Kelvin Chan
    19 Chan